Indemnity Plan In-Network Deductible (Single/Family) $400 / $1,200 Out-of-Pocket Maximum (Single/Family) $1,500 / $5,600 Coinsurance 80% Preventive Care 100% covered Primary Care Visit 20% after deductible Specialist Visit 20% after deductible Urgent Care $200 copay, then 20% after deductible Emergency Room 20% after deductible